Can chronic his bundle pacing be safely started in centers with lack of experience of this technique? Mid-term data from a multicentric registry

Abstract

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long-term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies showed that it was feasible and safe in expert centers with a vast experience of HBP. These results may not apply to less experienced centers. To evaluate feasibility and safety of permanent His bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of His bundle capture (HBC) thresholds. We included all patients who underwent pacemaker implantation with attempt of HBP in 3 hospitals between September 2017 and January 2019. All the 5 operators were novice for HBP. HBC thresholds were recorded at 3 months and 9 months follow-up. HPB was successful in 62 of 69 patients (89.9%); selective HBC was obtained in 48 patients while nonselective HBC occurred in 14 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 39 patients, sinus node dysfunction in 6 patients and AV nodal ablation for non-controlled atrial arrhythmias in 24 patients. The mean procedure duration was 75 ± 8 min, and mean fluoroscopy duration was 10 ± 2 min The mean HBC threshold was 1.39 ± 0.26 V and did not increase at 3 months follow-up (1.08 ± 0.25 V, n = 48 patients) and 9 months follow-up (1.37 ± 0.31 V, n = 14 patients). Only 7 patients had HBC threshold > 2.5 V/0.5ms. There was no pericardial effusion, no pneumothorax and no device infection. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious dislodgement ( Fig. 1 ). His bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBC threshold did not increase at 3 months and 9 months follow-up.